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dc.contributor.authorAlford, Daniel P.en_US
dc.contributor.authorLaBelle, Colleen T.en_US
dc.contributor.authorRichardson, Jessica M.en_US
dc.contributor.authorO'Connell, James J.en_US
dc.contributor.authorHohl, Carole A.en_US
dc.contributor.authorCheng, Debbie M.en_US
dc.contributor.authorSamet, Jeffrey H.en_US
dc.date.accessioned2012-01-09T20:58:06Z
dc.date.available2012-01-09T20:58:06Z
dc.date.issued2007-1-17en_US
dc.identifier.citationAlford, Daniel P., Colleen T. LaBelle, Jessica M. Richardson, James J. O'Connell, Carole A. Hohl, Debbie M. Cheng, Jeffrey H. Samet. "Treating Homeless Opioid Dependent Patients with Buprenorphine in an Office-Based Setting" Journal of General Internal Medicine 22(2): 171-176. (2007)en_US
dc.identifier.issn1525-1497en_US
dc.identifier.urihttp://hdl.handle.net/2144/2930
dc.description.abstractCONTEXT Although office-based opioid treatment with buprenorphine (OBOT-B) has been successfully implemented in primary care settings in the US, its use has not been reported in homeless patients. OBJECTIVE To characterize the feasibility of OBOT-B in homeless relative to housed patients. DESIGN A retrospective record review examining treatment failure, drug use, utilization of substance abuse treatment services, and intensity of clinical support by a nurse care manager (NCM) among homeless and housed patients in an OBOT-B program between August 2003 and October 2004. Treatment failure was defined as elopement before completing medication induction, discharge after medication induction due to ongoing drug use with concurrent nonadherence with intensified treatment, or discharge due to disruptive behavior. RESULTS Of 44 homeless and 41 housed patients enrolled over 12 months, homeless patients were more likely to be older, nonwhite, unemployed, infected with HIV and hepatitis C, and report a psychiatric illness. Homeless patients had fewer social supports and more chronic substance abuse histories with a 3- to 6-fold greater number of years of drug use, number of detoxification attempts and percentage with a history of methadone maintenance treatment. The proportion of subjects with treatment failure for the homeless (21%) and housed (22%) did not differ (P=.94). At 12 months, both groups had similar proportions with illicit opioid use [Odds ratio (OR), 0.9 (95% CI, 0.5–1.7) P=.8], utilization of counseling (homeless, 46%; housed, 49%; P=.95), and participation in mutual-help groups (homeless, 25%; housed, 29%; P=.96). At 12 months, 36% of the homeless group was no longer homeless. During the first month of treatment, homeless patients required more clinical support from the NCM than housed patients. CONCLUSIONS Despite homeless opioid dependent patients' social instability, greater comorbidities, and more chronic drug use, office-based opioid treatment with buprenorphine was effectively implemented in this population comparable to outcomes in housed patients with respect to treatment failure, illicit opioid use, and utilization of substance abuse treatment.en_US
dc.language.isoenen_US
dc.publisherSpringer-Verlagen_US
dc.rightsCopyright Society of General Internal Medicine 2007en_US
dc.subjectBuprenorphineen_US
dc.subjectDrug dependenceen_US
dc.subjectPrimary careen_US
dc.subjectHomelessnessen_US
dc.titleTreating Homeless Opioid Dependent Patients with Buprenorphine in an Office-Based Settingen_US
dc.typearticleen_US
dc.identifier.doi10.1007/s11606-006-0023-1en_US
dc.identifier.pubmedid17356982en_US
dc.identifier.pmcid1824722en_US


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